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Medicaid expansion decision looms for many states

Montana Gov. Brian Schweitzer is anticipated to address the expansion in his new budget. | AP Photo

Of course, states can still kick the can. Colorado Gov. John Hickenlooper, a Democrat, filed a budget earlier this month that cited lack of guidance from Washington as a reason to delay a final decision. Hickenlooper told POLITICO in July that he anticipates his state embracing expansion but possibly later than 2014, when expansion could first take effect.

Other governors, including the newly reelected Earl Ray Tomblin, a West Virginia Democrat, have pressed the Obama administration for more details. The Republican Governors Association, led by Virginia Gov. Bob McDonnell, has written to the Department of Health and Human Services twice seeking clarity on Medicaid expansion, including whether states would be penalized for partial or phased-in expansion. A spokesman for Utah Gov. Gary Herbert, also a Republican, said the state is awaiting more information from HHS.

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Even in those states in which governors decide they are ready to sign up, state legislatures could throw up roadblocks to expansion. In Arkansas, for example, Republicans took over both houses of the Legislature last week, casting doubt on Democratic Gov. Mike Beebe’s intention to expand Medicaid.

A Kansas official told POLITICO that the state’s Legislature has grown increasingly conservative in recent years — a foreboding sign for the prospect of expansion. Gov. Sam Brownback, a Republican, remains skeptical, albeit noncommittal. A budget from Brownback is due at the start of the legislative session in January.

A roundup of other states:

— Alabama: A spokeswoman for Gov. Robert Bentley said the Republican still has “serious concerns” about the cost. “We are carefully evaluating the issues and will make fully informed decisions,” the spokeswoman said.

— Georgia: Looks likely to reject expansion. Republican Gov. Nathan Deal told reporters in August that he had no intention of expanding the state’s Medicaid rolls, and Republican majorities in the Legislature were reaffirmed last week.

— Iowa: This state, too, is poised to turn down expansion, with Republican Gov. Terry Branstad’s spokesman telling POLITICO it’s “highly unlikely” and could cost too much. Branstad is due to file a budget when the Legislature convenes in January.

— New Jersey: Republican Gov. Chris Christie has been skeptical. A spokesman indicated that a decision could be in the offing, but he declined to make “pre-announcements with media.” Christie’s budget is due in February.

— North Carolina: Gov.-elect Pat McCrory, a Republican set to succeed Democrat Bev Perdue, is weighing his options. Per a spokesman: “Gov.-elect McCrory stated during the campaign that we must first fully understand the long-term implications of the Medicaid expansion and will be reaching out and consulting advisers, experts and other governors about the best way forward.”

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Readers' Comments (5)

A lot of big talk. Any Governor ho doesn t work for his citizens and get it mostly paid for out of the federal tax revenues is so hoplessly ideological he/she should be recalled. That fact is these same people get coverage in the emergency rooms and the state eats that bill.At least the state would have control over auditing who is eligible and can work to get them off it.Like I said. Big talk. In the end even the idiot republicans know how to count.

In an unusual move the AMA recently discontinued psychiatry billing codes. No more medication management code. No bundled psychotherapy plus medication management. What an interesting thing to do. If Medicaid does significantly expand the AMA has just made it harder for emotionally and behaviorally disturbed children to be seen.

No one has seen the new fee schedules for the new codes so it is impossible to determine whether psychiatrists will face a 40% revenue loss or come out about the same. What is clear is that paperwork requirements will double. And the "caring" part of psychotherapy has been devalued. Now, if a patient is doing better - the doctor will get paid less... as if the longterm relationship with the patient has no intrinsic value.

If you are concerned about this change in emotional, behavioral, and mental health care... you now have someone to call - - - your congressman. Congress has full authority over health insurance companies, hospitals, and health care practitioners. No longer will hospitals and insurance companies squash your complaints. Let your Congressman's office know about anything you don't like about the health changes underway. Health care belongs to us now - we the people.

The ACA may actually reduce access to care for our most vulnerable populations.

The 32 million newly insured will try to double their consumption of health care and middle- and upper-middle-income families will have more generous coverage than they have now, but there will be no increase in supply.